Stenosis of the intracranial internal carotid arteries is an extremely dangerous condition, according to a retrospective study from the Cleveland Clinic. At the recent Joint Conference on Stroke and Cerebral Circulation in New Orleans, David Marzewski, MD, reported that 40% of these patients die during the five years after diagnosis.

Others at the meeting agreed with Marzewski that the dire prognosis of this condition emphasizes the importance of a multicenter, randomized trial that is currently in progress to determine whether external carotid-internal carotid (EC-IC) bypass surgery or antiplatelet therapy can improve life expectancy.

Sixty-nine patients seen at the Cleveland Clinic between 1966 and 1977 who had greater than 50% angiographically proved stenosis of an intracranial internal carotid artery were identified by Marzewski, neurologist Anthony Furlan, MD, neurosurgeon John Little, MD, and radiologist Michael Modic, MD. The diagnosis in 24 cases was transient ischemic attacks (TIAs) and in 22 cases, stroke.